Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.36 / $83.91 / $167.94	Facility	26	$49.36	$83.91	$167.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.55 / $196.91 / $410.29	Professional		$165.55	$196.91	$410.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.36 / $63.32 / $122.13	Professional	26	$49.36	$63.32	$122.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.53 / $133.58 / $296.57	Professional	TC	$111.53	$133.58	$296.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.96 / $202.00 / $333.96	Professional		$157.96	$202.00	$333.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.39 / $63.32 / $97.57	Professional	26	$50.39	$63.32	$97.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.56 / $137.55 / $231.77	Professional	TC	$107.56	$137.55	$231.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $238.40 / $282.33 / $1,045.53	Professional		$238.40	$282.33	$1,045.53
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.91 / $71.77 / $84.19	Professional	26	$64.91	$71.77	$84.19
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.63 / $217.43 / $276.14	Professional	TC	$166.63	$217.43	$276.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.28 / $330.64 / $529.16	Professional		$145.28	$330.64	$529.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.86 / $75.00 / $140.44	Professional	26	$44.86	$75.00	$140.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.92 / $246.82 / $402.93	Professional	TC	$108.92	$246.82	$402.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.13 / $194.57 / $239.54	Professional		$162.13	$194.57	$239.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.41 / $61.04 / $74.04	Professional	26	$49.41	$61.04	$74.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.73 / $135.27 / $165.78	Professional	TC	$112.73	$135.27	$165.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $80.03 / $129.58 / $208.00	Facility	26	$80.03	$129.58	$208.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.00 / $244.00 / $469.00	Professional		$79.00	$244.00	$469.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $83.08 / $308.91 / $521.79	Professional		$83.08	$308.91	$521.79
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.54 / $81.62 / $123.92	Professional	26	$61.54	$81.62	$123.92
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $118.32 / $240.05 / $360.07	Professional	TC	$118.32	$240.05	$360.07
United Facility/Professional Professional Modifier Low / Median / High Price $158.08 / $260.83 / $470.26	Professional		$158.08	$260.83	$470.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.73 / $74.65 / $115.03	Professional	26	$45.73	$74.65	$115.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.26 / $182.95 / $383.74	Professional	TC	$107.26	$182.95	$383.74